Provider Demographics
NPI:1205403318
Name:WALBURG, KARISSA (SLP)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:WALBURG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8722 N EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1323
Mailing Address - Country:US
Mailing Address - Phone:712-363-2738
Mailing Address - Fax:
Practice Address - Street 1:8722 N EDISON AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1323
Practice Address - Country:US
Practice Address - Phone:712-363-2738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078813235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist